Sarcoidosis as a Great Mimicker: Diagnostic Challenges in a Patient With Coccidioidomycosis

TL;DR

A patient initially diagnosed with sarcoidosis was later found to have a fungal infection, highlighting the importance of thorough diagnosis.

Contribution

This case emphasizes the diagnostic challenges of sarcoidosis mimicking fungal infections and the need for comprehensive evaluation.

Findings

The patient's symptoms initially attributed to sarcoidosis were later linked to a systemic fungal infection.

Failure to consider fungal infections in sarcoidosis diagnosis can lead to inappropriate treatment and worsened outcomes.

Abstract

Sarcoidosis presents as a systemic granulomatous disease of unknown etiology, characterized by the development of non-caseating granulomas that commonly affect the lungs, lymph nodes, skin, and eyes. Manifestations of various conditions such as infections, neoplasms, autoimmune, cardiovascular, and drug-induced diseases can bear resemblance to sarcoidosis. Coccidiosis, attributed to protozoan parasites of the Coccidia genus, primarily affects the intestinal tract but may also display systemic symptoms akin to those of sarcoidosis.

In this particular case, we present a 46-year-old immunocompetent gentleman who had an extensive disease despite the patient's well-controlled diabetes and absence of residency in an endemic area with fungal infection, his only pertinent part of the history was his travel to endemic areas for short periods that raised the possibility of thinking about the disseminated fungal infection. The patient's symptoms initially attributed to and treated as sarcoidosis, which later did not respond to steroids, led us to consider other potential causes, including systemic fungal infection

Misdiagnosis of the sarcoidosis bears the risk of inappropriate treatment, potentially leading to exacerbated patient outcomes. Consequently, it is imperative for healthcare providers, particularly rheumatologists, to augment vigilance and conduct comprehensive diagnostic assessments encompassing microbiological testing and histopathological examination.

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